﻿<%@ page language="java" pageEncoding="UTF-8"%>
<%
  String path = request.getContextPath();
  String basePath = request.getScheme() + "://" + request.getServerName() + ":" + request.getServerPort() + path + "/";
%>
<%
  String email = (String) session.getAttribute("email");
  String thirdemail = (String) session.getAttribute("thirdemail");
%>



<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<base href="<%=basePath%>">
<head>
  <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
  <meta http-equiv="X-UA-Compatible" content="IE=7">
  <title>填写信息</title>
  <meta content="" name="keywords">
  <meta content="" name="description">
  <link href="css/common.css" rel="stylesheet" type="text/css">
  <script type="text/javascript" src="./js/base.js"></script>
  <script type="text/javascript" src="js/menu.js"></script>
  <script type="text/javascript" src="js/time.js"></script>
  <script type="text/javascript" src="js/lb.js"></script>

  <script type="text/javascript" src="js/web/sendInfo.js" charset="utf-8"></script>
  <script type="text/javascript">
      function checkLogin() {
          if ("<%=email%>" == "" || "<%=email%>" == "null") {
              alert("请先登陆!");
              return false;
          }
          else {
              top.location.href = "servlet/DoMethod?method=showMyInformation";
              return true;
          }
      }
      function checkUserLogin() {
          if ("<%=email%>" == "" || "<%=email%>" == "null") {
              alert("请先登陆!");
              return false;
          }
          else {
              top.location.href = "servlet/DoChatMethod?method=login";
              return true;
          }
      }
  </script>

  <!---reload-!-->
</head>
<body style="background:transparent url(images/bg.jpg) repeat scroll 0% 0%" onload="times()">
<div id="contain">

  <!-- 头 -->

  <jsp:include page="../web/top.jsp" flush="true"/>


  <!-- 头 -->


  <!-- 第二部分内容 -->
  <div class="box" style=" margin-top:1px;   background: url(images/pbg.gif);">
    <div class="left">
      <jsp:include page="../web/left.jsp" flush="true"/>

    </div>
    <div class="right">
      <div class="boxtitlebg mbnav"><a href="">首页</a> &gt; 填写挂号信息</div>
      <!--内容-->
      <div style="padding:10px">
        <form action="servlet/OrderInfo?method=showConfirmSendInfo" method="post" onsubmit="return checkSendInfo()">
          <table id="detail" height="300" border="0" cellpadding="0" cellspacing="0"  width='960px' align="center">
            <tr>
              <td height="40" colspan="3"> <font color="0099FF" size="3"><strong>填写信息</strong></font></td>
            </tr>
            <tr>
              <td colspan="3" height="20"><hr color="#99CCFF" style="height:1px"/></td>
            </tr>
            <tr>
              <td width="80"><font color="#666666" size="2">患者姓名：</font></td>
              <td width="320"><input id="name" type="text" name="name" style="width:170px;height:19px;padding-top: 3px"/></td>
              <td width="247" colspan="2"><font color="#666666" size="2">请填写真实的姓名。</font></td>
            </tr>
            <tr>
              <td><font color="#666666" size="2">移动电话：</font></td>
              <td><input id="movePhone" type="text" name="movePhone" style="width:170px;height:19px;padding-top: 3px"/></td>
              <td colspan="2"><font color="#666666" size="2">固定电话与移动电话至少选填一项。</font></td>
            </tr>
            <tr>
              <td><font color="#666666" size="2">通信地址：</font></td>
              <td><input id="address" type="text" name="address" style="width:300px;height:19px;padding-top: 3px"/></td>
              <td colspan="2"><font color="#666666" size="2">请正确填写。</font></td>
            </tr>
            <tr height="80">
              <td colspan="3" style="padding-left: 110px">
                <input type="submit" value="提交" style="height: 32px;width:60px; padding-top: 3px"/>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                <input type="reset" value="重置" style="height: 32px;width:60px; padding-top: 3px"/>
              </td>
            </tr>
          </table>
        </form>

      </div>
      <!--内容-->
    </div>
  </div>
  <!-- 第二部分内容 -->

  <!--底部-->

  <jsp:include page="../web/bottom.jsp" flush="true"/>
</div>
</body>
</html>




